Distribution of substance-P nerves inside the infrapatellar fat pad and the adjacent synovial tissue: a neurohistological approach to anterior knee pain syndrome

Bohnsack, Michael; Meier, F; Walter, G. F.; Hurschler, Christof; Schmolke, S.; Wirth, Carl Joachim; Rühmann, O.

doi:10.1007/s00402-005-0796-4

Cited by 99 publications

(85 citation statements)

References 35 publications

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“…Experimental pain is acute and transient and does not necessarily reproduce knee OA pain, but for obvious reasons it is not possible to induce chronic pain experimentally. Nevertheless, the infrapatellar fat pad has nociceptive innervation (36), and is a source of pain in knee OA (37). The healthy subjects were significantly younger than the knee OA patients, and the patients were obese (BMI Ͼ30) in contrast to the healthy volunteers, but there are no relationships between either age or BMI and the peak knee moments used in the present study (44,45).…”

Section: Discussionmentioning

confidence: 71%

“…Recently, experimental pain was induced in the infrapatellar fat pad as a model of anterior knee pain leading to changes in quadriceps muscle coordination (34,35). The infrapatellar fat pad has nociceptive innervation (36) and is a source of pain in knee OA (37). The structure is intraarticular yet extrasynovial, reducing the risk of intrasynovial infection upon injections.…”

Section: Introductionmentioning

confidence: 99%

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Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

Henriksen¹,

Graven‐Nielsen²,

Aaboe³

et al. 2010

Arthritis Care & Research

149

112

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Objective. Medial knee osteoarthritis (OA) is characterized by pain and associated with abnormal knee moments during walking. The relationship between knee OA pain and gait changes remains to be clarified, and a better understanding of this link could advance the treatment and prevention of disease progression. This study investigated changes in knee moments during walking following experimental knee pain in healthy volunteers, and whether these changes replicated the joint moments observed in medial knee OA patients. Methods. In a crossover study, 34 healthy subjects were tested on 3 different days; gait analyses were conducted before, during, and after pain induced by hypertonic saline injections (0.75 ml) into the infrapatellar fat pad. Isotonic saline and sham injections were used as control conditions. Peak moments in frontal and sagittal planes were analyzed. The results were compared with data from 161 medial knee OA patients. The patients were divided into less severe OA and severe OA categories, which was based on radiographic disease severity of the medial compartment. Results. Experimental knee pain led to reduced peak moments in the frontal and sagittal planes in the healthy subjects, which were similar to the patterns observed in less severe OA patients while walking at the same speed. Conclusion. In healthy subjects, pain was associated with reductions in knee joint moments during walking in a manner similar to less severe knee OA patients. The experimental model may be used to study mechanically-driven knee OA progression and preventive measures against abnormal joint loading in knee OA.

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Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

Henriksen¹,

Graven‐Nielsen²,

Aaboe³

et al. 2010

Arthritis Care & Research

149

112

View full text Add to dashboard Cite

show abstract

“…It is already known that inflammation leads to angiogenesis and sensory nerve growth along new blood vessels in osteoarthritic joints [13]. In the immunohistochemical analysis, neovessels and accompanying nerve growth have been reported in synovium [14] and fat pads [15,16] of osteoarthritic joints. However, to our knowledge, nobody has clearly demonstrated that these sensory nerves along vessels play an important role in patients' symptoms.…”

Section: Discussionmentioning

confidence: 99%

Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

Okuno

Korchi

Shinjo

et al. 2014

Cardiovasc Intervent Radiol

118

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Purpose Osteoarthritis is a common cause of pain and disability. Mild to moderate knee osteoarthritis that is resistant to nonsurgical options and not severe enough to warrant joint replacement represents a challenge in its management. On the basis of the hypothesis that neovessels and accompanying nerves are possible sources of pain, previous work demonstrated that transcatheter arterial embolization for chronic painful conditions resulted in excellent pain relief. We hypothesized that transcatheter arterial embolization can relieve pain associated with knee osteoarthritis. Methods Transcatheter arterial embolization for mild to moderate knee osteoarthritis using imipenem/cilastatin sodium or 75 lm calibrated Embozene microspheres as an embolic agent has been performed in 11 and three patients, respectively. We assessed adverse events and changes in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores. Results Abnormal neovessels were identified within soft tissue surrounding knee joint in all cases by arteriography. No major adverse events were related to the procedures. Transcatheter arterial embolization rapidly improved WOMAC pain scores from 12.2 ± 1.9 to 3.3 ± 2.1 at 1 month after the procedure, with further improvement at 4 months (1.7 ± 2.2) and WOMAC total scores from 47.3 ± 5.8 to 11.6 ± 5.4 at 1 month, and to 6.3 ± 6.0 at 4 months. These improvements were maintained in most cases at the final follow-up examination at a mean of 12 ± 5 months (range 4-19 months). Conclusion Transcatheter arterial embolization for mild to moderate knee osteoarthritis was feasible, rapidly relieved resistant pain, and restored knee function.

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“…Subsynovial tissue and/or vascular synovium of bursae may contribute to nociception in a manner analogous to the synovial lining of the tibofemoral joint [17]; this nociceptive role could explain why bursectomy is sometimes helpful in refractory GTPS [18]. Furthermore, research examining the vascular and adipose subsynovial tissue may increase our understanding of the relationship between bursa and closely adjacent tendon pathology.…”

mentioning

confidence: 99%

Increased substance P expression in the trochanteric bursa of patients with greater trochanteric pain syndrome

et al. 2014

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Greater trochanteric pain syndrome (GTPS) is a pathology that can involve the trochanteric bursa or the tendons which attach to the greater trochanter. To clarify the potential importance of bursa versus tendon pathology and of substance P (SP) in contributing to pain in this condition tendon and bursa tissue biopsies were obtained from 34 patients with GTPS and 29 control subjects. Specimens were evaluated via light microscopy for histopathological and morphological differences, as well as using immunohistochemistry for macrophages (CD68), cells (CD45) and SP. Bursa [stroma score, mean (SD): 4.18 (1.65) vs. 2.53 (1.61), p = 0.051] and tendon [Bonar score, mean (SD): GTPS mean (SD) 12.65 (2.0), control (10.43 (4.84), p = 0.04] from subjects with GTPS demonstrated more extensive signs of pathology than specimens from control subjects. There was a significantly greater presence of SP in the bursa (frequency: 9/12 vs. 6/16, p = 0.047), but not in the tendon (8/12 vs. 8/15, p = 0.484) of subjects with GTPS compared to controls. An increased presence of SP in the trochanteric bursa may be related to the pain associated with GTPS.

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Distribution of substance-P nerves inside the infrapatellar fat pad and the adjacent synovial tissue: a neurohistological approach to anterior knee pain syndrome

Cited by 99 publications

References 35 publications

Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

Gait changes in patients with knee osteoarthritis are replicated by experimental knee pain

Transcatheter Arterial Embolization as a Treatment for Medial Knee Pain in Patients with Mild to Moderate Osteoarthritis

Increased substance P expression in the trochanteric bursa of patients with greater trochanteric pain syndrome

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